Anon: He is always very sympathetic, and regularly prescribes emollients and steroids. However - understandably, since GPs can hardly be expected to be experts on everything - he has not thought that there is anything else that can be done to treat my eczema.

DrB: What is your experience getting advice from your dermatologist?

Anon: I obtain a much more targeted range of emollients and steroids, so that I have different ones of each for different parts of the body and different situations. Again, the majority of her efforts are focused on emollients and dealing with flare-ups - she hasn’t had anything to suggest on stopping the scratching itself, other than to take antihistamines.

Anon: A couple of years ago I spent some time looking into eczema books, in the hope that there would be some out there that would offer more insight or ideas. I found The Eczema Solution book - which sets out the Combined Approach. It jumped out at me as a real treatment programme which (a) had been shown to work and (b) was something I could do myself.

Anon: It really made sense, and struck a chord. All the treatments I had were undermined by constant daily scratching, so trying to improve my skin with steroids etc was an impossible job - my scratching was making it worse far faster than it could heal. I also learned lots about how eczema occurs and how it is supposed to be treated - nobody had every taught me before how to use emollients and steriods properly. If they had, the results were not terrific so I could easily have forgotten the instructions!

However, it is hard work, and requires a lot of willpower. To count constantly - and then to really try to make the replacement behaviour stick - basically means you are devoting some degree of concentration and effort to the method at every waking moment. I have had a few abortive attempts at the programme, where I got to a certain stage - but then either I ran out of energy and willpower, or life became super-busy and I let myself “take a break for a couple of days”.

DrB: What made you decide to combine using The Eczema Solution with blogging about it on Twitter?

Anon: I realised that I needed some sort of external support to bolster my resolve and willpower, so I could make it all the way through the programme. Twitter has a community for pretty much everything, so I thought it would be worth a go - I had no idea whether or not it would work!

Anon: 50% is chronic and longstanding. The rest is the remnant of the flare-up that hit me after Christmas, the week before last!

DrB: You have now completed the first week of the programme. Tell us about how it has gone!

Anon: Pretty well. It does make such a difference to feel like I am taking positive action, rather than just waiting for the eczema to get bad again. The online element is definitely helping. It has added an extra layer to my commitment.

Anon: A majority of my scratching is not because of itch - see my progress blogs on Twitter! I might easily have 500 or more scratching episodes in a day, and on the day I drew the picture of where the eczema is, I estimated only 15% of scratching was due to itch. The counter made all my unconscious habit of scratching apparent - I would not have realised this without the counter!

DrB: So most of your scratching is linked to something else, rather than itching?

Anon: Exactly so: like, I tend to pick a lot, at bits of dry skin, as if I am making it better! And I scratch away when I get stressed, or just thinking, and when I am tired - also if it is too hot, and when I am bored, or just chatting, or if reading, or sometimes simply procrastinating! All this without any itch!

DrB: Great stuff! You have a lot of awareness of your habit now. Are you all ready for week two? Are you fully kitted out with your treatment?

Anon: Absolutely! All three levels, all understood and ready to go! At Level 1: For my emollients, to prevent my skin drying, I have Doublebase for general use, but I prefer Diprobase ointment for my face when it is badly affected. I am using Epaderm when bathing and showering, and Cetraben for my hands. I try always have a moisturiser with me when out and about, and if I forget, I get anything I can on the run! At Level 2: My topical steroids, for eczema and itching, are Eumovate ointment for my face, Betnovate cream for my body, Dermovate for where things are pretty bad, longstanding bits, and for my scalp eczema I am using Betacap. And at Level 3: for habit reversalfor the scratching, I’ve now got into the habit of counting and will continue to measure my progress. I have made some plans for skin-save behaviours for different situations, so I am now keen to put them into action and watch the number of clicks per day fall. I am OK with the special fists tactic, but have found the skin pinch or press makes an itch worse! Luckily I have discovered in my case that a great majority of my scratching is not from itch, so that isn’t going to be a problem!

DrB: You are all set then! We will continue read your blogs on Twitter and follow your progress there. After the first two weeks using all three levels of The Combined Approach we can have a Q&A review to keep you on track and iron out any problems….but you are now well on track to moving away from living with eczema, to living without it!